What is chronic rhinosinusitis?
When symptoms persist for >90 days with or without acute exacerbations
What are the three main types of chronic rhinosinusitis?
- Without polyps
- With polyps
- Associated with fungal infection
What are the categories of causes of chronic rhinosinusitis?
- Infective
- Chronic underlying problems
What organisms most commonly cause chronic rhinosinusitis?
- Anaerobes
- Gram -ve bacteria
- S. aureus
- Coagulase negative staph
What should all patients with suspected chronic rhinosinusitis receive?
Investigation for treatable underlying causes
What are the risk factors for chronic rhinosinusitis?
- Allergic rhinitis
- Asthma
- Immunosuppression
- Chronic dental infection
- Presence of foreign body
- Aspirin sensitivity
- Wegener’s granulomatosis
- Churg-Strauss syndrome
At least 2 of what symptoms must be present to be diagnosed with chronic rhinosinusitis?
- Thick, coloured nasal or post-nasal discharge
- Nasal obstruction or congestion
- Pain, tenderness and swelling around the eyes, cheeks, nose or forehead
- Reduced smell and taste in adults or cough in children
What other symptoms may be present in chronic rhinosinusitis?
- Ear pain
- Aching in upper jaw and teeth
- Cough
- Sore throat
- Halitosis
- Fatigue and irritability
- Nausea
Which symptom is more common in chronic rhinosinusitis than in acute?
Loss of smell
Which symptom is more common in acute rhinosinusitis than in chronic?
Facial pain
What may be noted on examination?
- Dull sinus ache
- Nasal polyps
- Mucosal inflammation
- Nasal purulence
Are investigations usually required?
No, but look for polyps
What are the differentials for chronic rhinosinusitis?
- Allergic rhinitis
- Non-allergic rhinitis
- Nasal polyps
- Cystic fibrosis
- Tumours
- Turbinate dysfunction
What type of management is first line for chronic rhinosinusitis?
Medical
What is medical management used irrespective of in chronic rhinosinusitis for first line?
Polyps
What is the medical management of first instance chronic rhinosinusitis?
- Nasal steroids
- Good dental hygiene
- Stop smoking
- Manage risk factors
What can be substituted for nasal steroids in severe cases of chronic rhinosinusitis?
Oral steriods
What specialist management can be considered in uncontrolled chronic rhinosinusitis?
- Antibiotics
- Endoscopic sinus surgery
What are the indications for endoscopic surgery in chronic rhinosinusitis?
- Complications
- Anatomical variations causing obstruction
- Allergic fugal disease
- Very symptomatic despite medical management
What is the most common complication of chronic rhinosinusitis?
Acute exacerbations
What are the other complications of chronic rhinosinusitis?
- Adenoiditis
- Laryngitis
- Orbital complications
- Cavernous sinus thrombosis
- Intracranial complications
- Osteomyelitis
- Mucocoele formation
- Psychological problems associated with chronic pain and ill health
What are the orbital complications of chronic rhinosinusitis?
- Cellulitis
- Orbital abscess
What are the intracranial complications of chronic rhinosinusitis?
- Meningitis
- Abscess formation
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Epistaxis55
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Neck Lumps36
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Parapharyngeal Abscess28
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Sialolithiasis30
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Ludwig's Angina28
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Epiglottitis27
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Sjögren’s syndrome34
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Acute Rhinosinusitis41
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Chronic Rhinosinusitis23
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Retropharyngeal Abscess35
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Otitis Externa48
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Acute Otitis Media31
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Chronic Suppurative Otitis Media41
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Otitis Media with Effusion36
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Otosclerosis29
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Vertigo31
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Allergic Rhinitis43
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Tonsillitis29
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Obstructive Sleep Apnoea Syndrome58
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Auricular Haematoma25
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Tympanic Membrane Perforation20
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Sialadenitis20
